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“We must always take sides. Neutrality helps the oppressor, never the victim. Silence encourages the tormentor, never the tormented.”—Elie Wiesel (1)

Milestones always cause me to reflect not on what has been accomplished, but rather on what else needs to be completed and what else needs to be improved. This should be the challenge of a responsible journal. At this second anniversary as Editor-in-Chief, I do not feel differently about JACC—although I have been pleased to learn that the readers (through multiple surveys) appreciate the simplicity of our new design and the consumable nature of the new features: Central Illustrations, Clinical Perspectives, and Audio Summaries. In fact, as of April 2016, >2 million people have downloaded the podcasts of the audio summaries. From the beginning, the JACC Editors and I recognized that busy cardiovascular specialists have less time to read all of the medical data that gets published each week, so we attempted to create unique ways to make data simple and consumable without losing its insightfulness.

However, I rarely think of what we have completed, and my mind continues to focus on changes that we must make to produce a high-quality journal. As you may have noticed of late, I have begun to focus my Editor’s Pages on issues that, in my opinion, require advocacy from leaders in our field, such as discussing the dangers of physician advertising (2), defending the pertinence of clinical examination and auscultation (3), or cautioning the editors and authors of peer-reviewed journals about potential dangers of rushing to publish data too quickly (4). These are important issues about which I am tremendously invested, and they require strong advocacy. Even within my own institution, these Editor’s Pages have resulted in healthy debate. In fact, due to the feedback that I continue to receive from these Editor’s Pages, I have been convinced that JACC may be an appropriate forum for advocacy, in particular, when we look for avenues to better serve our patients and academic endeavors—which is always our mission as cardiovascular specialists and investigators.

For example, let us focus on the very worrisome issue of the tobacco industry. Evidence about continued trends in mortality as a result of smoking has led me to recognize that industry is the cause of this pandemic, and without further aggressive advocacy, we will continue to lose the battle against it. Worldwide, >1 billion people use tobacco, resulting in approximately 6 million deaths/year (5). The tobacco industry’s documented history of subverting control efforts required innovative approaches by the World Health Organization (WHO)—led by Dr. Gro Harlem Brundtland—including invocation of its constitutional authority to develop treaties. In 2003, WHO member states adopted the WHO Framework Convention on Tobacco Control (FCTC). In the decade since, 177 countries have ratified and started to implement its full provisions.

After 10 years of the FCTC, how are things progressing? The answer is not well. Of the 177 countries, only 35% are on track to meet the target (6). For politicians who sign up with targets set far into the future, it may appear easy; however, delivery is another matter. The cause of the tobacco pandemic is the tobacco industry—lethal but still lawful—and its predatory efforts to preserve and grow profits by exploiting markets in middle- and low-income countries (6). The industry has resources by which it undermines and distorts tobacco policy in many countries. Thus, there is a need to monitor, expose, and address the aggressive tactics of tobacco companies.

Pursuing this problem of the tobacco industry, JACC must join advocates to address practical steps as opposed to theoretical policies, including (7):

1. It is time to act on the unacceptability of the damage caused by the tobacco industry by banning all forms of tobacco advertising, promotion, and sponsorship.

2. Present tobacco control efforts—so-called business-as-usual—will be insufficient. The most urgent priority is the inclusion of many more advocacy efforts on tobacco reduction. The public should be alerted to the dangers of tobacco through more effective health warnings and mass media campaigns.

3. Implementation of the WHO-FCTC in all countries, with full engagement from all sectors.

4. A United Nations’ high-level meeting on tobacco use appears to be an urgent need.

In conclusion, these are the types of issues that we will be examining going forward to ensure that we are properly informing and engaging the clinical and academic cardiovascular community holistically. Although our overarching objective will always be to publish high-quality clinical papers through a simple and insightful approach, certain important advocacy considerations may begin to enter the pages of JACC, when appropriate. Again, this is a challenge of any responsible journal.

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